Adam's Crohn's

Monday, June 11, 2012

On May 12th, 2012, Canadians can help cook up a cure!Visit any M&M Meat Shops location across Canada to support the 24th Annual M&M Meat Shops Charity BBQ Day benefiting Crohn’s and Colitis Foundation of Canada (CCFC). M&M Meat Shops franchisees, staff and thousands of volunteers from coast-to-coast will grill hamburgers and hot dogs to meet the 2012 fundraising goal of $1.5 million.

Visit any M&M location across Canada to enjoy a hamburger or hot dog, a drink and a bag of chips for a minimum donation of only $3.00. All proceeds go directly to the CCFC to fund research to help find the cause and cure for Crohn's disease and ulcerative colitis.

M&M Meat Shops 24th annual Charity BBQ Day to help support the Crohn’s and Colitis Foundation of Canada (CCFC).

Saturday, May 12th, 2012 from 10 AM – 4 PM

Every M&M Meat Shops location across Canada.To help us reach our goal to raise $1.5 million at this year’s Charity BBQ Day to support Crohn’s and Colitis research.

Volunteer, donate or come out and show your support! Enjoy a hamburger or hot dog, a drink and a bag of chips for a minimum donation of only $3.00.

Become a Star! From March 30th until May 13th, there are 3 great ways to be a SUPERstar for CCFC:

Buy a Coupon Book for $5 with $50 in savings, sign a Star & triple your chances to WIN a $500 M&M Gift Card.

Crohn's disease and ulcerative colitis are two forms of inflammatory bowel disease (IBD)More than 200,000 Canadian men, women and children suffer from IBDThe incidence of Crohn's and colitis in Canada is thought to be among the highest in the worldThough inflammatory bowel disease can strike at any age, it usually appears between the ages of 15 and 25, or later between 45 and 55Crohn's and colitis are painful and chronic diseases characterized by inflammation and sores on the gastrointestinal wall, both diseases go into periods of "flare-up" and remissionDespite significant differences, both Crohn's disease and ulcerative colitis are unpredictable, with inflammations ranging from mild and easily manageable to severe and debilitatingSymptoms associated with Crohn's and colitis include severe diarrhea, abdominal cramps, weight loss, decreased appetite, extreme fatigue, nausea. Youngsters may experience a slower growth rate than peers.Neither drugs nor surgery can cure Crohn's disease, but removal of the colon can completely eliminate ulcerative colitisTHERE IS NO KNOWN CAUSE OR CURE FOR CROHN'S DISEASE OR ULCERATIVE COLITIS

Gutsy Walk is the Crohn’s and Colitis Foundation of Canada’s (CCFC’s) most energetic and fun fundraising event. On June 10, 2012, thousands of Canadians at almost 80 locations across the country will walk together to raise money to find a cure for inflammatory bowel disease (IBD), which is made up of Crohn’s disease and ulcerative colitis.

CCFC-funded IBD research has confirmed what we have suspected for years – Canada has one of the highest rates for Crohn’s disease and ulcerative colitis in the world and those rates are increasing. In fact, one in 160 Canadians is living with IBD. The Gutsy Walk is a great way to spread awareness of IBD and raise much-needed funds to support essential research.Gutsy Walk started as the Heel 'n' Wheel-a-Thon in 1996 in 24 communities and has grown to nearly 80 communities throughout Canada. The success of the event is completely due to our amazing volunteers and dedicated participants..Over the last 16 years, Gutsy Walk has grown from raising $280,000 per year to more than $2 million per year for research. Due to your pledge-earning efforts, there are more IBD researchers hard at work in Canada, and therefore CCFC receives more excellent research proposals every year. For that reason, and because we know first-hand the toll IBD takes on people, we are aiming higher this year with the goal to raise $3.3 million.

There’s another good reason to take probiotics, like those found in yogurt and fermented foods. Not only do they boost immunity and help ward off drug-resistant superbugs, but they could also help improve mood, new research suggests.

In a study done on mice, researchers at St. Joseph’s Healthcare in Hamilton and the University College in Cork, Ireland found that rodents fed a certain type of probiotic, or good bacteria, showed reduced signs of stress, anxiety and depression.

Probiotics are living organisms that inhabit the gut, keeping intestinal flora in balance and stimulating the immune response.

For 28 days, the mice were fed the probiotic Lactobacillus rhamnosus JB-1. The study, which was published this week in the Proceedings of the National Academy of Sciences, found that the probiotics affected neurotransmitter receptors, altering brain activity in the hippocampus, amygdala and prefrontal cortex. These are areas of the brain associated with mood.

As well, the mice had less of the stress hormone corticosterone in their blood.

“This is the first-ever demonstration that harmless bacteria, found naturally in the intestine, can influence mood and behaviour in a normal animal,” said the study’s co-author Dr. John Bienenstock, director of the McMaster Brain-Body Institute at St. Joseph’s.

The findings suggest that changes in the gastrointestinal tract are communicated to the central nervous system via the vagus nerve, a long cranial nerve that extends from the brain to the abdomen. The discovery of this pathway is particularly significant Bienenstock said, explaining that electrical stimulation of the vagus nerve in humans has been shown to improve difficult-to-treat depression.

“That is a clue to us that this is not just curing depression in mice, but there is some hope that this could eventually be applied to the human,” he said.Bienenstock hopes to get approval from Health Canada to conduct a clinical trial, using Lactobacillus rhamnosus JB-1 on humans.

Meantime, he is continuing to study the impact of the probiotic on mice, trying to determine exactly how it stimulates the nervous system.

“(The study) highlights the idea that bacteria in the intestine can influence certain mood and behavioural disorders and identifies the gut as a possible target for treatment,” Bienenstock said.

Saturday, June 2, 2012

Who is Affected?

In the fall of 2008, the Crohn’s and Colitis Foundation of Canada (CCFC)
released its report, “The Burden of Inflammatory Bowel Disease in
Canada.” This landmark document revealed that over 200,000 Canadians
suffer from inflammatory bowel disease. IBD affects more people than
multiple sclerosis or HIV and is almost as prevalent as epilepsy and
Type 1 diabetes. In spite of that, IBD remains a closet disease,
shrouded in silence and relatively unknown.

Why is that? Perhaps it is because people with Crohn’s disease (CD) and
ulcerative colitis (UC) are reluctant to speak out about health issues
that have been taboo in polite conversation. It’s time for that to stop.
We need to bring this conversation out into the open and talk about a
disease that strikes more than 9,000 new patients every year.

The Costs of IBD

Canada has one of the highest incidences of IBD in the world. With an
annual cost of $1.8 billion to individuals, their families and society
at large, the burden of IBD is significant. In 2008, costs covered by
the health care system were estimated at $753 million; including
expenses such as hospitalization, surgery, medication and physician
visits. Not included in these estimates, but having as real a system
impact, are things like emergency visits, lab costs and other
consultations with other health professionals such as nurse
practitioners, dietitians and social workers.

In addition to the direct expenses to the health care system, it is
estimated that IBD incurs more than a $1 billion dollars every year in
indirect costs. These include short and long-term work absences,
productivity losses, caregiver work absences and patient out-of-pocket
expenses related to care, nutritional products, medication and
complementary therapies.

Beyond the economic impact, the emotional suffering inflicted by these
chronic diseases is incalculable. Quality of life, career choices, sense
of self-worth, intimacy and personal freedoms are all affected when
someone develops IBD. Over and above those concerns, the risk of
premature death for IBD sufferers is 47 per cent higher than the general
public, and the risk of developing colorectal cancer is also elevated.

The Challenges

Because they are often embarrassing to talk about, social stigma and
the silence surrounding CD and UC lead to a lack of public understanding
about the impact of IBD. IBD is currently not considered a chronic
disease under government health strategies. An enhanced level of public
and governmental awareness needs to be developed so that improved access
to IBD specialists, procedures and medication can be established
nationally. Also, improved employer understanding of the challenges
inherent in these diseases would be enormously helpful to those living
and working with the daily challenges of these diseases.

Is Inflammatory Bowel Disease (IBD) the same as Irritable Bowel Syndrome (IBS)?

You may have heard of irritable bowel syndrome (IBS) and wondered if it is the same as IBD. While often confused because their names are similar and their symptoms can seem comparable, the two are not the same.

Yes, both diseases affect the digestive tract. However, with inflammatory bowel disease, inflammation is the key characteristic. In irritable bowel syndrome it is thought that problems arise because of changes to bowel function or the way the brain senses what is going on in the bowel; inflammation does not play a role. It is possible to have IBS if you have been diagnosed with IBD. It is also possible to have just one or the other.Is there a special diet for people with IBD?

The short answer is, “NO.” Because everyone is unique, there is no standardized “IBD Diet” that will be the solution for those who have Crohn’s disease or ulcerative colitis. Beware of fad diets, new “health foods” that your friends are raving about, and do not stop eating. You need all the well-balanced nutrition that healthy foods can provide you.

Check out our booklet, “Food for Thought” for more details on what you should be doing with your diet if you have been diagnosed with IBD.

Does stress cause IBD?

Researchers do not know the cause(s) of IBD, but they DO know that stress is not one of them. Stress however, can aggravate your symptoms and possibly trigger a flare-up, in conjunction with a number of other factors.

The reverse is also true; IBD can cause stress. In other words, the presence of fatigue, gut pain, diarrhea, and sleep disturbances from having to get up during the night to go to the bathroom, can be stressful. As well, fatigue can be the result of the disease process itself and not just sleep disturbances.

Can I donate blood if I have IBD?

Having IBD does not automatically prevent you from donating blood. However, sometimes the medications that you are taking pose a problem. Contact your local blood donor clinic to find out if you are eligible to give. And remember – “It’s in you to give.”

How do I find a Gastroenterologist?

A referral to a gastroenterologist has to come from your family physician. Talk to your family physician and get a referral to a specialist who can work with you to control the symptoms of your IBD. While we do not make referrals to gastroenterologists, we've put together links to organizations that can help you find a doctor.

Where can I get help to pay for my IBD medications?

In Canada, when you are a hospital patient, the cost of your drugs is covered by provincial health plans.

However, when you are discharged, the cost of prescription medications has to be paid by you. For some, a company benefit plan may provide a subsidy. For others, a private insurance plan may cover the costs.

If you do not have a drug plan and require assistance to pay for your medications, you may be eligible for assistance from your provincial Drug Benefit Plan. Unfortunately, drug benefit assistance guidelines vary from province to province in Canada, so you need to investigate what medications are eligible in your place of residence.

How effective is fecal transplantation as a treatment option for IBD patients?

Fecal transplantation, (also known as 'Stool transplant, 'Human probiotic infusion' and 'Stool enema'), is an experimental procedure that has not shown efficacy for the treatment of IBD in controlled clinical trials to date. Research is ongoing in this area. There are potential known and unknown risks associated with experimental treatment of this nature.

Is the vaccine for the H1N1 flu virus safe for people with Crohn's or colitis? Would people with IBD qualify to be included in the first administration of vaccine due to our suppressed immune systems?

The chance of contracting H1N1 flu is not increased in patients with a diagnosis of Crohn's disease or ulcerative colitis. Therefore, there won't be priority for IBD patients. However, those patients on immunosuppressant drugs (azathioprine, 6-mercaptopurine, methotrexate, or anti-TNF agents) may be at increased risk. (Dr. Remo Panaccione, Director, Inflammatory Bowel Disease Clinic and Gastroenterology Training Program and Associate Professor of medicine, at the University of Calgary, says he personally recommends the seasonal flu vaccine to his patients who are on immunosuppressant drugs.) Different jurisdictions around the world are handling this differently because there is not much knowledge in the area.

The issue surrounding the H1N1 vaccine should be discussed with your doctor, as the local regulations will differ from province to province.

Does the Crohn’s and Colitis Foundation of Canada (CCFC) have anything local where I can get ongoing information?

Absolutely “YES”! CCFC has local chapters across the country. Participating in the activities of your local chapter will help you learn more about IBD, and give you the chance to meet other people with similar concerns and questions. Do yourself a favour, and become a member of CCFC.

What is the GEM project?

In 2007, the CCFC was very proud to announce the launch of the Michael J. Howorth Genetics, Environmental and Microbial (GEM) project. The GEM Project, named in honour of the previous CCFC National Executive Director, is a $5.5 million research investment over six years. During this time, researchers will investigate how early genetic and environmental interactions can set the stage for events that will eventually cause Crohn’s disease.

Researchers aim to recruit up to 5,000 healthy subjects (between the ages of 6 and 35 years), identified as being at high-risk for developing IBD. High risk is defined as having a sibling or parent (“first degree relative”) with Crohn’s disease. When recruited, biographical and environmental information of these healthy subjects will be collected, baseline intestinal permeability will be measured, and stool and blood studies will be collected and stored. Researchers expect some of these at-risk subjects to develop Crohn’s disease during the follow up period. At that point, the stored biological material will be studied in parallel with matched controls from the same group of at-risk subjects to look for genetic, environmental, immunological and microbial features which may explain onset of symptoms.

I want to make a difference. How do I enroll in the GEM Project?

Please click here to quickly find out more information about the GEM Project and whether or not you fit the criteria for the research study. Thank you for your interest.

What is the purpose of the Crohn’s and Colitis Foundation of Canada?

We are so glad you asked! CCFC’s Mission is to “Find the Cure”. We are dedicated to raising money for research into the cause of IBD – and we know that the cure will be found. In the pursuit of that cure, we also know that medical treatments will be discovered that will alleviate the suffering and pain that IBD patients experience.

CCFC is also dedicated to helping people learn about their disease. Through our website, patient information booklets, our magazine “the Journal” and education events, we are there to support you in your journey of discovery about inflammatory bowel disease.

Colorectal cancer is the third most common cancer in Canadian men and women and affects over 20,000 people annually. On a global scale, Ontario has the highest rate of this type of cancer in the world. The good news is that if detected early, there is a 90% chance that this type of cancer can be cured. In short, early detection is crucial to survival.

What has this got to do with IBD? People with IBD have an increased chance of developing colorectal cancer, correlating with the length of time they have had the disease.

Studies tell us that the probability of a person developing colorectal cancer after having IBD for 10 years is 2%. After that, risk continues to rise and is as high as 30% after 30 years. In other words, as age increases, so does risk.

But it is also true that everyone in the general population has an increased risk of developing colorectal cancer as aging occurs. In fact, the Colorectal Cancer Association of Canada (CCAC) recommends that everyone over the age of 50 should be screened for colon cancer. The CCAC also states that if you have a family history of the disease, screening should begin at an earlier age.

Regular colorectal screening is absolutely vital in the early detection of cancer. Again, let us stress that if detected early, colorectal cancer responds very well to treatment.

Screening is particularly important for those with IBD, because the early warning signs of cancer are similar to the symptoms of Crohn’s disease and ulcerative colitis. While people in the general population might become frightened if they detect blood in their stool, changes in their bowel habits, alternating diarrhea and constipation, persistent abdominal bloating and cramps, those with IBD would not regard these symptoms as uncommon or alarming.

What is “regular screening”? If a person has suffered from large bowel Crohn’s disease or ulcerative colitis for more than 10 years, annual or bi-annual colonoscopy is recommended. Tests such as a barium enema, fecal occult blood sampling and flexible sigmoidoscopy are not considered adequate because biopsy samples are not taken during these tests.

Even with regular screening, detection of cancer can be difficult in IBD patients. In spite of that, it is better for you to take the opportunity to be tested than to sit back and hope that all is well. Knowledge is essential in managing health.

It is important for people with IBD to manage the risks associated with their disease. Colorectal cancer poses a higher risk for those who have suffered from Crohn’s disease or ulcerative colitis for more than 10 years. The message is clear, “Be proactive – be informed – get screened”.

There is a lot of talk around the IBD community about the potential benefits of low-dose naltrexone (LDN) as a novel treatment for Crohn’s disease. The interest stems from two small pilot and follow-up studies by researchers Dr. Jill Smith and Ian Zagon at Pennsylvania State University, which suggest that a low dose of the generic drug naltrexone can improve symptoms and quality of life for some Crohn’s patients.

What is LDN therapy and is it a legitimate treatment option for IBD patients to consider?

Naltrexone hydrochloride is a blocker of the body’s natural opioid system. It was developed in the 1960s and later approved by the FDA to treat drug and alcohol dependence. With low-dose naltrexone therapy, patients receive a 4.5 milligram (mg) dose daily, about one-tenth of the normal FDA-approved dose of 50 mg for treating drug addiction and overdose.

Researchers don’t know exactly how LDN works. The proposed theory is that a low dose of the drug stimulates the body to make more of its endogenous (or “home-grown”) opioids, known as endorphins and enkephalins. A low dose is used because it blocks opioid receptors only temporarily, resulting in a rebound effect where more opioids are produced to compensate for a perceived deficiency. (A high dose blocks receptors continuously, which would prevent therapeutic effects from the opioids.) The higher opioid levels produced by the low dose of naltrexone help to control and reduce inflammation in the gut, and may have other beneficial effects on the immune system.

Dr. Keith Sharkey is the Crohn’s and Colitis Foundation of Canada Chair in IBD Research and well-known for his research on the role of the nervous system in IBD at the University of Calgary. Dr. Sharkey is encouraged that LDN shows promise in controlling inflammation and improving symptoms in some patients with Crohn’s disease, but cautions that the findings are preliminary and limited to a small number of patients treated for only 12 weeks at a single research centre.

“The encouraging aspect is that beneficial effects were seen in some patients and this suggests the endogenous opiate system is important in Crohn’s disease. Further clinical trials are absolutely warranted and low-dose naltrexone has to be tested in a multi-centre study,” he says.Dr. Sharkey emphasizes that there isn’t enough information yet to know whether LDN is effective, or who is most likely to benefit from the treatment. “This is not necessarily going to benefit everybody. We don’t know the optimal dose or the optimal way the drug should be used in Crohn’s patients. We don’t know for sure that it doesn’t do harm and an important question is whether it would interfere with existing therapies,” he says.

Despite those caveats, Dr. Sharkey believes it is worthwhile for patients interested in LDN to consider and discuss this treatment option with their doctors. “Talk to your doctor and ask whether it’s safe and appropriate for you,” he says.

One major benefit of these preliminary LDN studies is as a stimulus for more research in this area.

“This is a very exciting development from my perspective as a researcher. The promise is that we could target sites in the endogenous opioid system, and perhaps better regulate and control inflammatory conditions in the body. The ultimate would be to never get inflammation in the gut,” says Dr. Sharkey.

“If we can understand the endogenous opioid system better, we could perhaps prevent relapses from occurring as often or at all. If remission lasts longer, that’s as good as a cure.”

Vitamin D has gained recognition in the last few years as a nutrient that is key for good overall health, and bone health in particular. Known as the sunshine vitamin, Vitamin D is produced when the sun’s ultraviolet rays strike the skin. Much epidemiological research shows people who live in northern latitudes are more at risk of having inadequate levels of Vitamin D compared to their counterparts who live in southern latitudes.

A recent study published in the journal Gut shows geography also affects the incidence of inflammatory bowel disease (IBD): increasing latitude of residence was linked to an elevated incidence of Crohn’s disease and ulcerative colitis in a population of American women. Yet another study published in the journal Gastroenterology late last year demonstrated a connection between higher Vitamin D status and lower Crohn’s disease, suggesting greater Vitamin D intake is a means of decreasing the risk of Crohn’s disease.

Emerging research is pointing to Vitamin D and its role in the inflammatory process, and as a factor in the disease activity in patients with IBD, according to Dr. Gilaad Kaplan, a gastroenterologist with a research interest in IBD and Assistant Professor in the Departments of Medicine and Community Health Sciences at the University of Calgary.

“When we look at patients with Crohn’s disease and ulcerative colitis, and check their Vitamin D levels, they are usually deficient in Vitamin D,” notes Dr. Kaplan. But he says it’s not clear whether low Vitamin D levels are making the disease course worse in someone who has an established diagnosis of Crohn’s disease or ulcerative colitis, or whether IBD patients who have active IBD have a more difficult time absorbing Vitamin D.

Clinicians like Dr. Kaplan want to determine whether healthy stores of Vitamin D will reduce inflammation and quiet the disease activity in IBD patients, given the body of research suggesting Vitamin D decreases inflammation and regulates the immune system.

“The question is whether we can improve the disease course by taking Vitamin D,” he says. “In 2012, we can’t definitively say that by taking Vitamin D, you will improve the disease course. We need to do studies to show that."

But in the absence of those definitive studies, Dr. Kaplan recommends that his IBD patients take oral Vitamin D supplements to increase their Vitamin D levels, noting Vitamin D supplementation poses no harm. It can be a struggle to derive enough Vitamin D through diet and sun exposure, so a daily dose is recommended as an effective route to acquire enough Vitamin D.

And IBD patients shouldn’t assume they are getting enough Vitamin D daily in the summer months, as they still may be challenged to get enough sun exposure if they are working in an office most of the day, for example. Indeed, Vitamin D deficiency is not limited to the darker, winter months, stresses Dr. Kaplan.

“Patients with IBD should continue to take Vitamin D supplements in the summertime,” says Dr. Kaplan. “Even in the summertime, people can be Vitamin D deficient.”A future study that would shed more light on the impact of Vitamin D in the disease activity of IBD patients would involve a large sample of IBD patients with similar history and health status, where one group of patients would be administered sufficient doses of Vitamin D and one group would not get Vitamin D supplements. Investigators would then evaluate whether the patients getting vitamin supplementation had a clinical benefit in their course of disease.Anecdotally within CCFC’s IBD community, patients report that they experience less joint pain when they take Vitamin D supplements. Patients’ observations fit with scientific studies which tie IBD with suboptimal bone health. Furthermore, osteoporosis is a co-factor in IBD patients, and bone disease is attributed in part to a lack of Vitamin D.

No two IBD cases are exactly alike. That is why there is no “one size fits all” approach to IBD medication and treatment. The
drugs your doctor prescribes for you, the dosage and the effects you
experience are going to be unique to you. You and your physician must
work together to sort out what is the most effective regime for you when
you are in a flare­-up or in remission.

Medication

In general, medications fall into one of two very broad
categories: drugs that are used to reduce inflammation (and may
therefore reduce some of your symptoms) and those that are aimed only at
symptom-reduction and do not affect the inflammation in your gut.

Drugs that control the inflammation in your gut

Examples of the types of drugs available to combat inflammation include:

Sulfasalazine
and 5-Aminosalicylates (5-ASA): These drugs limit the production of
certain chemicals that trigger inflammation. This medicine is generally
prescribed to help combat milder attacks of IBD. Examples include
Mesalamines and Sulfalazine.

Steroids:
Steroids aim to reduce inflammation. This medicine is used in cases of
moderate to severe attacks of IBD. Some examples include Prednisone and
Hydrocortisone.

Immunomodulators:
This type of medicine alters how the body mounts an inflammatory
response. Patients using this type of drug should get into the habit of
regular hand washing during the day, as immunomodulators do suppress
your ability to fight infections in general. An example of this type of
drug is Methotrexate. These drugs are used by patients who have moderate
to severe attacks.

Biologicals:
These drugs target and block molecules involved in inflammation.
Biologics are the latest generation of medications and hold great
promise for relieving IBD. These drugs are used to combat moderate to
severe attacks. Some examples include Adalimumab (Humira) and Infliximab
(Remicade).

Antibiotics:
Antibiotics do not counteract inflammation directly, but decrease
infection that can cause and result from severe inflammation. Examples
include Ciprofloxacin and Metronidazole.

Drugs that manage symptoms

Note that many of these drugs are available “off the shelf” in
your pharmacy. You should NOT self prescribe; talk with your doctor
first.

Antidiarrheals: Do not take these during a flare-­up as they may cause other complications! Check with your doctor

Ointments and Suppositories: Off the shelf ointments can be applied around hemorrhoids to reduce swelling, itching, and inflammation. Most of these ointments contain a steroid such as hydrocortisone and will help to shrink inflamed tissue.

Antispasmodics: Relax muscles in the wall of the GI tract to reduce cramping

Bulk formers for stool: Soak up water in the stool, thereby firming it up and lessening looseness as well as frequency.